Clinical Scorecard: Development of an AI-driven system for correcting artifacts in intrarenal pressure measurements utilizing the LithoVue™ Elite ureteroscope: a collaborative effort by EAU endourology and AUSET

At a Glance

Key Highlights

• Postoperative infectious complications including sepsis occur in ~5% of RIRS cases, with elevated IRP as a modifiable risk factor.
• Direct IRP measurements are prone to artifactual spikes caused by sensor contact with renal or ureteral walls, distorting true pressure readings.
• An AI-based model was developed and validated to detect and correct IRP measurement artifacts using synchronized endoscopic video and waveform data.

Guideline-Based Recommendations

Diagnosis

• Use pressure-sensor-equipped flexible ureteroscopes (e.g., LithoVue™ Elite) for real-time IRP monitoring during RIRS.
• Correlate IRP waveform data with endoscopic video to identify artifactual pressure spikes.

Management

• Maintain IRP below the safe threshold of 30 mmHg to reduce pyelovenous backflow and infectious complications.
• Employ AI-driven artifact correction models to improve accuracy of IRP monitoring and guide intraoperative decision-making.

Monitoring & Follow-up

• Continuously monitor IRP throughout the procedure from ureteral access sheath placement until scope withdrawal.
• Calibrate pressure sensors prior to use by immersion in saline to zero baseline.
• Use automated irrigation systems or manual pumps with controlled pressure settings to manage irrigation flow.

Risks

• Elevated IRP increases risk of postoperative sepsis and pyelovenous backflow.
• Artifact-induced IRP spikes may lead to misinterpretation and inappropriate clinical decisions.

Patient & Prescribing Data

Adults undergoing RIRS or ECIRS for renal stones without severe comorbidities or contraindications.

Use of the LithoVue™ Elite ureteroscope with AI artifact correction enhances the reliability of IRP measurements, potentially reducing infectious complications by enabling better pressure control.

Clinical Best Practices

• Exclude patients with active urinary tract infection, bleeding diatheses, severe ureteral strictures, or ASA class III or higher from IRP monitoring studies.
• Perform RIRS or ECIRS following standardized protocols with appropriate patient positioning and access techniques.
• Use ureteral access sheaths and laser lithotripsy with controlled irrigation to optimize surgical conditions and IRP.
• Apply AI-based artifact detection models trained on synchronized video and pressure data to improve IRP measurement accuracy.
• Validate AI models on external datasets to ensure generalizability and robustness.

References

• EAU Guidelines on Urolithiasis
• LithoVue™ Elite Ureteroscope Product Information
• Study on IRP and infectious complications in RIRS